The metabolic syndrome (MetS) is a clustering of cardiovascular risk factors (CVRFs) (namely, obesity, diabetes mellitus, hypertension, and dyslipidemia) that is known to predict increased risks of cardiovascular disease and stroke.¹ Among them, diabetes mellitus in midlife and late life is consistently and strongly associated with subsequent dementia (particularly vascular dementia), as well as with mild cognitive impairment (MCI), a predementia syndrome known to confer an increased risk of progressing to dementia.² Studies show that hypertension in midlife is strongly associated with incident dementia in later life, particularly vascular dementia,² but late-life hypertension is not associated with dementia.^3,4 There are contradictory reports of associations of body and fat mass and total cholesterol level with incident dementia or vascular dementia in the elderly.^5-7

Evidence from observational studies suggests that diets high in omega‐3 long‐chain polyunsaturated fatty acids (PUFA) may protect people from cognitive decline and dementia. The strength of this potential protective effect has recently been tested in randomised controlled trials. To assess the effects of omega‐3 PUFA supplementation for the prevention of dementia and cognitive decline in cognitively healthy older people. We searched ALOIS ‐ the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register on 6 April 2012 using the terms: "omega 3", PUFA, "fatty acids", "fatty acid", fish, linseed, eicosapentaenoic, docosahexaenoic. Randomised controlled trials of an omega‐3 PUFA intervention which was provided for a minimum of six months to participants aged 60 years and over who were free from dementia or cognitive impairment at the beginning of the study. Two review authors independently assessed all trials. The review authors sought and extracted data on incident dementia, cognitive function, safety and adherence, either from published reports or by contacting the investigators for original data. Data were extracted by two review authors. We calculated mean difference (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI) on an intention‐to‐treat basis, and summarised narratively information on safety and adherence. Information on cognitive function at the start of a study was available on 4080 participants randomised in three trials. Cognitive function data were available on 3536 participants at final follow‐up. In two studies participants received gel capsules containing either omega‐3 PUFA (the intervention) or olive or sunflower oil (placebo) for six or 24 months. In one study, participants received margarine spread for 40 months; the margarine for the intervention group contained omega‐3 PUFA. Two studies had cognitive health as their primary outcome; one study of cardiovascular disease included cognitive health as an additional outcome. None of the studies examined the effect of omega‐3 PUFA on incident dementia. In two studies involving 3221 participants there was no difference between the omega‐3 and placebo group in mini‐mental state examination score at final follow‐up (following 24 or 40 months of intervention); MD ‐0.07 (95% CI ‐0.25 to 0.10). In two studies involving 1043 participants, other tests of cognitive function such as word learning, digit span and verbal fluency showed no beneficial effect of omega‐3 PUFA supplementation. Participants in both the intervention and control groups experienced either small or no cognitive declines during the studies. The main reported side‐effect of omega‐3 PUFA supplementation was mild gastrointestinal problems. Overall, minor adverse events were reported by fewer than 15% of participants, and reports were balanced between intervention groups. Adherence to the intervention was on average over 90% among people who completed the trials. All three studies included in this review are of high methodological quality. Direct evidence on the effect of omega‐3 PUFA on incident dementia is lacking. The available trials showed no benefit of omega‐3 PUFA supplementation on cognitive function in cognitively healthy older people. Omega‐3 PUFA supplementation is generally well tolerated with the most commonly reported side‐effect being mild gastrointestinal problems. Further studies of longer duration are required. Longer‐term studies may identify greater change in cognitive function in study participants which may enhance the ability to detect the possible effects of omega‐3 PUFA supplementation in preventing cognitive decline in older people. Les acides gras oméga-3 pour la prévention du déclin cognitif et de la démence Des données issues d'études observationnelles laissent penser qu'une alimentation riche en acides gras polyinsaturés à longue chaîne oméga‐3 (AGPI oméga‐3) peut protéger contre le déclin cognitif et la démence. La puissance de cet effet protecteur potentiel a été récemment examinée dans des essais contrôlés randomisés. Évaluer les effets de la supplémentation en AGPI oméga‐3 pour la prévention de la démence et du déclin cognitif chez les personnes âgées cognitivement saines. Le 6 avril 2012 nous avons effectué une recherche dans ALOIS, le registre spécialisé du groupe Cochrane sur la démence et les autres troubles cognitifs, à l'aide des termes : « omega 3 », PUFA, « fatty acids », « fatty acid », fish, linseed, eicosapentaenoic, docosahexaenoic (oméga‐3, AGPI, acides gras, acide gras, poisson, graines de lin, eicosapentaénoïque, docosahexaénoïque). Des essais contrôlés randomisés d'une intervention d'AGPI oméga‐3 poursuivie pendant un minimum de six mois sur des participants âgés d'au moins 60 ans ne présentant aucun signe de démence ou de troubles cognitifs au début de l'étude. Deux auteurs de la revue ont évalué les essais de façon indépendante. Les auteurs ont recherché et extrait les données sur la démence incidente, la fonction cognitive, la sécurité et l'observance du traitement, soit dans des rapports publiés soit en contactant les chercheurs pour obtenir les données originales. Deux auteurs de la revue ont extrait les données. Nous avons calculé la différence moyenne (DM) ou la différence moyenne standardisée (DMS), avec intervalles de confiance (IC) à 95 %, en intention de traiter et nous avons résumé narrativement les informations sur la sécurité et l'observance du traitement. Les informations sur la fonction cognitive en début d'étude étaient disponibles pour 4 080...